what is nasolacrimal drainage

Full Answer

What are nasolacrimal ducts?

Nasolacrimal ducts connect to the puncta and drain the rest of your tear fluid into the nose. What are the tear ducts? Tear ducts are another name for the nasolacrimal ducts.

Where does the nasolacrimal drainage apparatus drain?

Nasolacrimal drainage apparatus. The nasolacrimal drainage apparatus drains tears in a descending course through the lacrimal canaliculi leading to the lacrimal sac which drains into the and nasolacrimal duct in the nasolacrimal canal of the maxilla to the inferior nasal meatus below the inferior turbinate in the nasal cavity .

What happens if the nasolacrimal duct is blocked?

Obstruction of the nasolacrimal duct may occur. This leads to the excess overflow of tears called epiphora (chronic low-grade nasolacrimal duct occlusion). A congenital obstruction can cause cystic expansion of the duct and is called a dacryocystocele or Timo cyst.

What are the causes of nasal tear drainage?

The tear drainage system may not be fully developed or there may be a duct abnormality. Often a thin tissue membrane remains over the opening that empties into the nose (nasolacrimal duct). Age-related changes. As you age, the tiny openings that drain tears (puncta) may get narrower, causing blockage. Infection or inflammation.

What does the nasolacrimal duct drain into?

The purpose of the nasolacrimal system is to drain tears from the ocular surface to the lacrimal sac and, ultimately, the nasal cavity. Blockage of the nasolacrimal system can cause tears to flow over the eyelid and down the cheek; this condition is epiphora.

What are three signs of nasolacrimal?

Symptoms of nasolacrimal duct obstruction often affect only one eye and include:Constant and severe tearing.Painful swelling near the inside corner of the eye.Recurrent eye inflammation (conjunctivitis) or tear duct infections (dacryocystitis)Mucus or pus discharge from the lids and surface of the eye.Blurred vision.

Where does the nasolacrimal duct drain tears?

Lacrimal glands create tears. Puncta are small openings at your eye corner where tears flow out. Nasolacrimal ducts connect to the puncta and drain the rest of your tear fluid into the nose.

What is the lacrimal drainage system?

The drainage system consists of the lacrimal puncta, canaliculi, lacrimal sac, and the nasolacrimal duct. This active system pumps tears from the conjunctival sac into the inferior meatus of the nose. Tears flow along the lid margins and conjunctival fornices. They are spread across the surface of the eye by blinking.

How do you tell if your tear duct is blocked?

Signs and symptoms of a blocked tear duct include:Excessive tearing.Redness of the white part of the eye.Recurrent eye infection or inflammation (pink eye)Painful swelling near the inside corner of the eye.Crusting of the eyelids.Mucus or pus discharge from the lids and surface of the eye.Blurred vision.

How do you get rid of a blocked nasolacrimal duct?

Surgery. The surgery that's commonly used to treat blocked tear ducts is called dacryocystorhinostomy (DAK-ree-oh-sis-toe-rye-nohs-tuh-me). This procedure opens the passageway for tears to drain out your nose again. You'll be given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure ...

Where is nasolacrimal duct located?

nasal cavityThe nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards.

How do you unblock a tear duct without surgery?

Blocked tear ducts can resolve on their own, but your doctor may recommend massaging the tear duct to help it open. You can massage the outside of your child's nose (from the eye to the corner of the nose) with a clean index finger.

Can sinus cause blocked tear ducts?

Sinusitis: Frequent sinus infections can lead to inflammation and scarring, which increase the risk of blockages. Nasal allergies: As with sinus problems, nasal allergies cause swelling, which may lead to scarring and result in blocked tear ducts.

Where do lacrimal sacs drain to?

Tears enter the duct system at the lacrimal punctae and conduct through canaliculi within the eyelids. The canaliculi drain into the lacrimal sac. Tears continue down the intra-osseous lacrimal duct where they exit into the nasal cavity at the inferior meatus.

What is the function of lacrimal system?

The lacrimal gland is located within the orbit above the lateral end of the eye. It continually releases fluid which cleanses and protects the eye's surface as it lubricates and moistens it. These lacrimal secretions are commonly known as tears.

What produces tears in our eyes?

Your tears are produced by lacrimal glands located above your eyes. Tears spread across the surface of the eye when you blink. They then drain into small holes in the corners of your upper and lower lids before traveling through small channels and down your tear ducts to your nose.

What does nasolacrimal mean in medical terms?

Medical Definition of nasolacrimal : of or relating to the lacrimal apparatus and nose.

How is the nasolacrimal duct formed?

These epithelial cords fuse to form the nasolacrimal drainage system. Maxillary process grows medially and overrides the paraxial mesoderm of the nasolacrimal process. Canalization of the epithelial cords occurs simultaneously throughout their entire length, beginning at 4 months' gestation.

How do you say nasolacrimal duct?

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Where does the nasolacrimal duct open into?

The inferior meatus is below and lateral to the inferior nasal concha; the nasolacrimal duct opens into this meatus under cover of the anterior part of the inferior concha.

What Is A Nasolacrimal Duct Obstruction?

The eyes usually have just enough tear fluid to keep them wet. Some young children seem to have a constant overflow of tears, however.Tears normall...

Where Exactly Is The Nasolacrimal duct?

The nasolacrimal ducts start underneath the skin at the corners of the eyes closest to the nose. They then go down through the bones of the face an...

How Does The Doctor Know When A Child Has Nasolacrimal Duct Obstruction?

If a young child seems to have constantly overflowing tears, there might be a nasolacrimal duct obstruction. The doctor will look for the following...

How Is Nasolacrimal Duct Obstruction Treated?

A careful examination is necessary to help the doctor decide whether a child has a nasolacrimal duct obstruction and recommend the right treatment....

What If The Obstruction Does Not Go away?

It can take up to 1 year for the nasolacrimal duct to open on its own. If the obstruction is causing other problems, the doctor might recommend a p...

Is There Anything That Can Be Done If Probing Does Not Fix The Obstruction?

Sometimes the obstruction cannot be cleared by probing. An infection can also have the side effect of blocking the nasolacrimal duct completely. Th...

How common is nasolacrimal duct obstruction?

There is a high rate of spontaneous resolution of congenital nasolacrimal duct obstruction with approximately 70% of affected children being free of the symptoms by 3 months of age, and over 90% recovering by their first birthday. In one study, 20% of healthy infants showed evidence of defective lacrimal drainage during the first year of life. Spontaneous resolution occurs by 6 months of age in approximately 90% of infants with congenital nasolacrimal duct obstruction (NLDO). From those infants with persistent symptoms at 6 to 10 months of age, approximately two-thirds have a resolution within 6 months. The cases that persist beyond 12 months of age are likely to require probing of the lacrimal duct. A study showed that those patients with significant nasolacrimal obstruction, meaning nonresponsive to two or more probing procedures, with or without intubation, 35% have nasolacrimal duct obstruction, 15% have punctal agenesis, 10% have congenital fistulas, and 5% have craniofacial defects.[5]  The condition affects males and females equally. It has reported no difference in the racial incidence of congenital nasolacrimal system abnormalities.

What is the lacrimal drainage structure?

The lacrimal drainage structures form during the fifth week of gestation as a crease between the frontons and maxillary processes , known as the nasolacrimal groove or naso-optic fissure 10. A cord of ectodermal tissues separates from the surface and enters this groove. This tissue eventually canalizes and forms the lacrimal sac and nasolacrimal duct. This process of canalization usually begins by week 8 and is completed by birth. Tears are produced by the main and accessory lacrimal glands and drain medially into the puncta, then flow through the canaliculi to the lacrimal sac, and then through the nasolacrimal duct into the nose. Incomplete canalization is the most common cause of congenital nasolacrimal duct obstruction (NLDO) and occurs at the distal end resulting in an imperforate membrane at the valve of Hasner. [4]

What is NLDO in infants?

Infants with congenital nasolacrimal duct obstruction (NLDO) present with a history of chronic or intermittent tearing and debris on the eyelashes. Conjunctival erythema is not characteristic although irritation from overflow tearing and chronic rubbing of the eyes may cause mild redness of the lower and upper eyelid. On physical examination, there is usually an increase in the size of the tear meniscus. Palpation of the lacrimal sac may cause reflux of tears and/or mucoid discharge onto the eye through the puncta.

What causes punctal membrane?

Punctal membrane caused by a chronic follicular conjunctivitis. Membranes may also develop in the presence of nasolacrimal duct obstruction or canaliculitis. Contributed by Professor Bhupendra C. K. Patel MD, FRCS

What is the complication of NLDO?

This is a rare complication of isolated congenital NLDO. Acute dacryocystitis can be complicated by preseptal or orbital cellulitis, sepsis, or meningitis and should be treated promptly with systemic antibiotics. Although antibiotic therapy is frequently prescribed for dacryocystitis, the definitive treatment of dacryocystitis is usually surgical.

Can nasolacrimal obstruction cause infection?

Congenital nasolacrimal anomalies, particularly obstruction, can lead to various clinical manifestations including infection due to stasis of fluid within the lacrimal system. Obstruction can partially allow the duct to drain the tears produced, except in situations where increased tear production is present (wind, cold weather) and tear overflow results. The normal flora bacteria usually present within the tears do not cause problems because they are flushed readily into the nares. In NLDO, the stasis of fluid within the lacrimal sac creates a moist, warm environment favorable to bacterial growth.

What is the term for the overflow of the nasolacrimal duct?

Obstruction of the nasolacrimal duct may occur. This leads to the excess overflow of tears called epiphora (chronic low-grade nasolacrimal duct occlusion). A congenital obstruction can cause cystic expansion of the duct and is called a dacryocystocele or Timo cyst.

What is the canal containing the nasolacrimal duct called?

The canal containing the nasolacrimal duct is called the nasolacrimal canal .

What is the name of the duct that carries tears from the eye to the nose?

Outline of bones of face, showing position of air sinuses. The nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct ...

Why do you close the nasolacrimal duct?

This is for the same reason when applying some eye drops it is often advised to close the nasolacrimal duct by pressing it with a finger to prevent the medicine from escaping the eye and having unwanted side effects elsewhere in the body as it will proceed through the canal to the Nasal Cavity.

What is the duct lined with?

Like the lacrimal sac, the duct is lined by stratified columnar epithelium containing mucus-secreting goblet cells, and is surrounded by connective tissue.

Where does the nasolacrimal duct begin?

The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold ( valve of Hasner or plica lacrimalis ). Excess tears flow through nasolacrimal duct which drains ...

Which duct carries tears from the lacrimal sac of the eye into the nasal cavity?

Nasolacrimal duct. Carries tears from the lacrimal sac of the eye into the nasal cavity. The lacrimal apparatus. Right side. Outline of bones of face, showing position of air sinuses. The nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the ...

How common is nasolacrimal duct obstruction?

Over 5% of infants have clinical symptoms of nasolacrimal duct obstruction affecting one or both eyes. Most (approximately 90%) clear spontaneously during the first year of life.

What causes nasolacrimal duct obstruction in children?

The most common cause is a membrane at the end of the tear duct (valve of Hasner) that is present in about 50% of newborns but it normally disappears soon after birth. Other causes of blocked tear ducts in children include:

What is a tear duct obstruction?

Tears normally drain from the eye down the nose through the tear duct or nasolacrimal duct. If one looks in the mirror the openings of the tear ducts could be seen in the corners of the upper and lower eyelids. They look like 2 small dots, one in the upper lid, one in the lower lid and are called puncta. Tear duct obstruction prevents tears from draining through this system normally [See figure 1]. If the tear duct is blocked, there will be backflow of tears and discharge from the eye.

What are the signs/symptoms of tear duct obstruction?

Blockage of the drainage system causes tears to well up on the surface of the eye and overflow onto the eyelashes, eyelids, and down the cheek. This usually occurs within the first month of life.

What is the treatment of a blocked tear duct?

When obstruction is persistent, one or more of the following treatments may be recommended: tear duct massage, topical antibiotic eye drops, tear duct probing, balloon tear duct dilation, and tear duct intubation.

How does tear duct massage work?

The caregiver uses firm pressure with the index finger in a downward movement over the tear duct, located medially to the eye (Figure 2) . The hydrostatic pressure normally causes reflux of the mucus and tears through the puncta, thus preventing superinfection in the tear sac. It may also help open the membranes that block the tear duct at the opening in the nose.

When should tear duct probing be performed?

If the tear duct remains blocked after 8 to 10 months of age, there is much less of a chance for the obstruction to resolve on its own and a procedure such as nasolacrimal duct probing may be performed.

Where do the nasolacrimal ducts drain?

Nasolacrimal ducts connect to the puncta and drain the rest of your tear fluid into the nose.

What is a blocked tear duct?

A blocked tear duct is a full or partial obstruction (blockage) in the nasal (nose) passageways that drain tears. If you have a blocked tear duct, your eyes may be itchy, irritated and watery. Another name for a blocked tear duct is nasolacrimal duct obstruction. Lacrimal refers to tears.

Why are my tear ducts blocked?

Causes of blocked tear ducts include: Age: As you get older, your puncta may naturally narrow. Congenital blockages: Some babies are born with tear ducts that are narrow or not fully formed (dacryostenosis).

What is the tear system?

Typically, your tear system keeps your eyes slightly wet but not too watery. Your tear system has three parts: Lacrimal glands create tears. Puncta are small openings at your eye corner where tears flow out. Nasolacrimal ducts connect to the puncta and drain the rest of your tear fluid into the nose.

What causes a tear duct to block?

Injury: Any eye injury near the tear ducts, even a scrape from tiny dirt particles, can cause a blockage. Tumors: A tumor anywhere near the tear ducts, such as in the nose, can cause blocked tear ducts.

What is a snip punctoplasty?

Snip punctoplasty: Your provider makes two or three small incisions around your puncta. These incisions create a larger tear duct opening. Snip punctoplasty is a common treatment for partial blockages.

What does it mean when your eye dye doesn't drain?

If the dye does not drain from your eye, it could mean you have a blocked tear duct. Eye imaging: Your provider puts a special, safe dye in your eye. This dye travels through your tear drainage system. It shows up on an X-ray, CT scan or MRI to help your provider find the blockage.

What is the purpose of a probe and irrigation of the nasolacrimal duct?

A probe and irrigation of the nasolacrimal duct is done to open the valves between the nasolacrimal (tear) duct and the nose.

Why do they flush saline through the eye duct?

A small amount of sterile saline, a liquid similar to tears, is flushed through the duct to ensure the system is open. When the doctor sees that the saline can flow freely through the ducts, the procedure is over. The doctor will decide whether or not to patch the eye.

How does a doctor dilate the puncta?

The doctor first dilates (widens the opening) in the puncta (the two little holes in the eyelid) with a tiny metal dilating tool. Then a thin, flexible probe is gently moved through the duct until it reaches the inner nose.

Why does my nose not open?

Sometimes a valve or thin membrane of skin-like tissue inside the nose fails to open before birth and blocks part of the tear drainage system. When babies have a blocked valve, the tears cannot drain properly and start to back up inside the system spilling over the eyelid and onto the cheek.

Why is the lumen of the nasolacrimal duct compressed?

Although the inciting event in this process is unknown, clinicopathologic study suggests that compression of the lumen of the nasolacrimal duct is caused by inflammatory infiltrates and edema. This may be the result of an unidentified infection or possibly an autoimmune disease.

What is the treatment for nasolacrimal fracture?

Naso-orbital fractures may involve the nasolacrimal duct. Early treatment by fracture reduction with stenting of the entire lacrimal drainage system should be considered. However, such injuries are often not recognized or are initially neglected as more serious injuries are managed. In such cases, late treatment of persistent epiphora usually requires dacryocystorhinostomy.

What is a dacryocystorhinostomy?

Dacryocystorhinostomy. A dacryocystorhinostomy is the treatment of choice for most patients with acquired nasolacrimal duct obstruction. Surgical indications include recurrent dacryocystitis, chronic mucoid reflux, painful distension of the lacrimal sac, and bothersome epiphora.

What is the name of the duct that is flushed in a cat?

Flushing the nasolacrimal duct in a cat. In irrigation test, a lacrimal irrigation cannula is passed into the punctum and advanced through the canaliculus to the lacrimal fossa. Clear water or saline is then irrigated through the cannula.

What is the name of the condition where the lacrimal duct fails to open?

Congenital nasolacrimal duct obstruction, or dacryostenosis, occurs when the lacrimal duct has failed to open at the time of birth, most often due to an imperforate membrane at the valve of Hasner.

What is the pain on the side of the nose?

Pain at the side of the nose suggests dacryocystitis . Nasolacrimal duct obstruction is more common with increasing age and more common in females than males.

What is the term for tears arising from a lacrimal sac fistula?

Obstruction of the nasolacrimal duct leads to the excess overflow of tears called epiphora.

What is the name of the gland that drains tears?

Tear glands and tear ducts. The tear glands (lacrimal glands), located above each eyeball, continuously supply tear fluid that's wiped across the surface of your eye each time you blink your eyelids. Excess fluid drains through the tear ducts into the nose. When you have a blocked tear duct, your tears can't drain normally, ...

Where do tears drain from?

From there tears travel down a duct (the nasolacrimal duct) and drain into your nose. Once in the nose, tears are reabsorbed.

What is the name of the gland that supplies tear fluid?

Close. Tear glands and tear ducts. Tear glands and tear ducts. The tear glands (lacrimal glands), located above each eyeball, continuously supply tear fluid that's wiped across the surface of your eye each time you blink your eyelids. Excess fluid drains through the tear ducts into the nose. When you have a blocked tear duct, your tears can't drain ...

Why do my tear ducts get blocked?

Infection or inflammation. Chronic infection or inflammation of your eyes, tear drainage system or nose can cause your tear ducts to become blocked.

What causes a blocked tear duct in the eye?

Chronic eye inflammation. If your eyes are continually irritated, red and inflamed (conjunctivitis), you're at higher risk of developing a blocked tear duct.

Can a baby have a blocked tear duct?

Many infants are born with a blocked tear duct. The tear drainage system may not be fully developed or there may be a duct abnormality. Often a thin tissue membrane remains over the opening that empties into the nose (nasolacrimal duct). Age-related changes.

Is a tear duct blockage always correctable?

A blocked tear duct is almost always correctable. Treatment depends on the cause of the blockage and the age of the affected person.

What is the lacrimal gland?

lacrimal apparatus a group of organs concerned with the production and drainage of tears; it is a protective device that helps keep the eye moist and free of dust and other irritating particles. The lacrimal gland, which secretes tears, lies over the upper, outer corner of the eye; its excretory ducts branch downward toward the eyeball. A constant stream of tears washes down over the front of the eye and is drained off through two small openings located in the inner corner of the eye. Through these openings the tears pass into the lacrimal canaliculus, then through the lacrimal sac into the nasolacrimal duct and finally into the nasal cavity.

Where does the word "lachrymal" come from?

Note that the spelling ‘lachrymal’ has neither logical nor etymological justification. The term comes from Latin lacrima , a tear.

Overview

Clinical significance

Obstruction of the nasolacrimal duct may occur. This leads to the excess overflow of tears called epiphora (chronic low-grade nasolacrimal duct occlusion). A congenital obstruction can cause cystic expansion of the duct and is called a dacryocystocele or Timo cyst. Persons with dry eye conditions can be fitted with punctal plugs that seal the ducts to limit the amount of fluid drainage and retain moisture.

Additional images

See also

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